Can focal therapy truly “thread the needle” between active surveillance and radical prostate cancer treatment? In this episode of BackTable Urology, host Dr. Tiwa Akinsola is joined by Dr. George Schade from the University of Washington to explore focal therapy as a middle ground between active surveillance and radical treatments. Dr. Schade reviews non-radiation energy modalities including HIFU, TULSA/HI-DU, cryotherapy, and irreversible electroporation, highlighting patient selection, institutional experience, technical nuances, and quality-of-life outcomes from recent trials.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps
00:00 - Introduction
02:09 - Overview of Focal Therapy Modalities
04:46 - Deciding Between HIFU and IRE
06:56 - Evidence and Trials
09:40 - Counseling Patients on Outcomes
12:09 - Building a Focal Therapy Program
16:12 - Navigating Insurance and Appeals
21:48 - Managing Large Glands And TURP
25:12 - Preop Workup Essentials and OR Workflow
32:32 - Overcoming the Learning Curve
35:52 - PostOp Recovery and Surveillance
39:04 - Options for Managing Recurrence
42:44 - Challenges with Repeat Ablation
44:56 - Final Takeaways

---

More about this episode
The conversation covers candidate selection and confirmatory biopsy, perioperative technique and recovery, and ongoing surveillance with PSA, MRI, and biopsy. Dr. Schade also discusses challenges with insurance approvals, building a focal therapy practice, and options for managing recurrence, including repeat ablation, surgery, or radiation. The episode examines how to balance cancer control with quality of life and reviews the evolving evidence base supporting focal therapy’s role in prostate cancer treatment.

---

Resources

Irreversible Electroporation for Prostate Tissue Ablation in Patients with Intermediate-risk Prostate Cancer: Results from the PRESERVE Trial:
https://www.sciencedirect.com/science/article/pii/S030228382500346X

Focal therapy of localized prostate cancer
https://pubmed.ncbi.nlm.nih.gov/35996758/

Focal Therapy for Prostate Cancer: Available Technologies, Patient Selection, Follow-Up Protocols and Reported Outcomes
https://pubmed.ncbi.nlm.nih.gov/41339218/

---

BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app